Copaxone injection sites

I'm a rank beginner at this (just did my 6th injection) so I'd appreciate experienced opinions. My Support Services weekly injection map/planner has only 4 sites for each arm, 8 for the hips, 10 for the thighs and 19 in the abdomen. That seems excessively burdensome for the arms and not using the abdomen enough. For some of us, sadly, there is SO much adipose territory in the abdomen I'm tempted to consider the upper and lower row of the abdomen two separate 8 site zones and go there twice in a rotation. I think I could pretty easily make it three rows really and have the injections no closer than they are in the arm (which I want to 'officially' divide into 8 sites instead of 4) . Are there reasons I shouldn't use the abdomen twice or three times in a rotation? I know that will throw off matching body zones with days of the week, but using my abdomen proportionately seems worth it. Thoughts? Thanks.

Yes, there is a reason. The 7 body sites are distributed around the body because that is how the studies were done. It is based on the idea of a subcutaneous absorption and allowing the immune system to see the compound as a "normal substance" appearing systemically (every where) around the body.

If you inject any substance subcutaneously in one place too often, you also risk lipoatrophy. I find the arms to be one of my more comfortable locations to inject. My legs seem to itch more after injection. I also do not use the autoinjector, so I can inject much slower which seems to keep the welts to a minimum.

If there are sites that bother you or you would prefer a different group of sites, talk to your doctor. The SS nurse recently told me that the doctor could suggest other injection sites but they can't .......

Hi Merriam and welcome to the forum. Hope you stick around so we can get to know you.

I had the same thinking as you when I started Copaxone. I decided my abdomen had as much right to a left and right division as my limbs do. That gives eight general areas that I simply rotate around. It's worked well for me.

I don't try to match the day of the week to a specific body part. I can skip a site if I want to (like my arms the day before wearing short sleeves to my son's wedding) or need to (like when I had a large healing bruise in the area) without a bunch of recalculations or confusion. I just move onto the next site in the lineup.

Shared Solutions shows 63 sites on their diagram. They only instruct you to rotate among the sites. You can feel free to make up any schedule that works for you (and your subcutaneous fat) as long as you follow the general guidelines. (They are in the front of your planner if you want to review.) A schedule that makes sense to you will be easier to remember and work with. For me, that meant injections soon consumed less of my time and thought. The easier it is the more likely I am to stick with it.

Reactions often differ from site to site. Early on, I had some thoughts about skipping a thigh every other rotation as they weren't my favorite. I stuck with it though and as time passed the sites have become equally useable (although arms, legs, abdomen and hips still all vary in the way they receive the medication).

I stick to the autoinjector as it works well for me to insure consistent injection depth and delivery. It has a harsh sound but delivers fine. Don't forget to massage sites after 24 hours. It seems to be the technique most often left out by injection coaches. You can read more about member experiences with Copaxone by typing it in the small search box (above right) that says "Search this Community".

Good luck and let us know how it goes. Different questions sometimes come up as therapy continues.
Mary

"The 7 body sites are distributed around the body because that is how the studies were done. It is based on the idea of a subcutaneous absorption and allowing the immune system to see the compound as a "normal substance" appearing systemically (every where) around the body."

Interesting Bob. I had never heard this before. Can you send me in the right direction to read more please?

It is in the Teva study designs and there New Drug Approval (NDA) Application to the FDA . There was a concern about over activating the immune system in one area of the body and the chance of increased reactions, so they designed the original subcutaneous patterns to avoid over injection in any one area. This pattern also reduces the incidence of lipoatrophy.

There have been several studies done by Teva for IM vs. SQ and there is currently a clinical trial to look at the effectiveness of 40 mg every other day vs. 20 mg every day. All of the previous studies are contained at the bottom of the drug information sheet (in that really tiny print) that Shared Solutions send with just about every mailing. The information sheet is also in every box of Copaxone.

Failure to follow the dosing and injection site recommendation is considered "off label" use of the drug. Any physician has the right to prescribe an approved drug in an off label use. So, if your doctor authorized alternate injection sites, Teva (Shared Solutions) will call that off label since it is not based on the locations specified in their drug application to the FDA.

With Momenta Pharmaceuticals bringing their version of Glatiramer acetate (M356) to the FDA via NDA, this may change for their compound.

Bob's right - rotate those sites. If you don't rotate them enough, you risk lipoatrophy.

The problem with Copaxone (at least for me) is that some of the sites are more likely to cause an IPIR. So after the arms were gone, all I had left were the thighs, abdomen, and hips. After serious denting in all of the above, I had a problem finding a spot that wasn't damaged. I eventually had to switch.

@Mary - I would be very confused about 8 sites because I have my seven memorized by the starting site on Friday, the day I received my first injection. When I forget where I am supposed to shoot next, i do my mental macarena and count stomach, thigh, thigh, hip, hip, arm, arm.... beginning on Friday until I reach that day. Confused ? I often am and 8 sites would really throw me off because I would loose my Friday reference point. :-)

@Merriam - fortunately the IPIR problem that Jensequitur had is fairly rare - I'm sure the SS nurse discussed this possibility with you. I have been on copaxone since Oct. 2008 and have not had any problem with the lipoatrophy, but I'm also not too worried about that because my bikini days are long over LOL

So right there, Bob. Once I injected in stretch mark -- I wasn't trying to -- I just wasn't thinking that it would matter. And did that hurt! Learned that lesson. Of course, now it takes a bit longer to find a spot that isn't a stretch mark ...

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